Form 3-1384 Bid Sheet - National Wildlife Refuge System

F WS Form 3-1384 (Rev. 04/2020) OMB Control. No. 1018-0102

U.S. Department of the Interior Expiration Date ##/##/####

BID SHEET

National Wildlife Refuge System

[Insert Refuge Name]

[Insert Refuge Address/Contact Info/etc. – optional]

Refuge may customize form by removing any fields not needed and/or reorganizing fields. Refuges may insert detailed instructions for submission of bids.

APPLICANT INFORMATION:

Name (Proposal Submitter): __________________________________________________________________________

Partner Name (if applicable): __________________________________________________________________________

Name of Business or Farm: __________________________________________________________________________

Mailing Address: ___________________________________________________________________________________

Tax ID #: ___________________________________ Phone Number: _____________________ Work Cell

E-mail Address: ______________________________________________________

BID INFORMATION: (Refuges will customize this section to reflect their bidding formula – examples are shown in italics below but can be removed or customized as necessary.)

Write your bid amount for the corresponding Unit(s) in the space(s) provided below. If you are not bidding on a particular unit, leave that space blank or write N/A.

Unit Name: _________________ Bid Amount ($/acre): _________________

Grazing Bid: Amount bid per AUM is $_________________

Amount of Animal Units you possess (AU) _________________

Amount you should expect to pay for 1 month is line 1) X line 2) Total $_________________

Farming Bid: $__________per acre X _____ acres X _____ years = $$_________________

I bid _________ per acre for [year/effective period].

Timber Bid:

Species: _________________ Product _________________ Vol. (est) ______MBF Bid Price ($/MBF) ______

ADDITIONAL INFORMATION (Refuges will customize this section to reflect any additional information needed for the applicant to demonstrate that they meet the objective criteria of the opportunity– examples are shown in italics below but can be removed or customized as necessary)

Current Pesticide Applicator’s License: Yes No (Check One) Type: _____________ Expiration: __________

Current Organic Farming Certificate: Yes No (Check One) Cert #: _____________ Expiration: __________

Current Certified Logging Certificate: Yes No (Check One) Cert #: _____________ Expiration: __________

Describe how your proposed activity, based on your background, knowledge and experience, meets the objective criteria by which the Service will evaluate your application as outlined in the Service’s notice of the opportunity (Notice). In addition, please identify how your proposed activity is different from the description of the opportunity outlined in the Notice.

Describe your experience in farming/grazing/timber operations (including number of years) or other related experience.

Describe your experience relating to cultivating high-energy crops, organic crops, and/or crops under similar environmental conditions to the Refuge:

Please describe what in-kind services you are willing to assist the Refuge with in conducting a successful cooperative agriculture program (e.g. mowing, disking, erosion mitigation, constructing and maintaining fence to contain livestock, levee construction and laser leveling):

What is your response time if livestock escape fences?

List all available equipment in good working condition, for example harvesters, tractors, implements, trucks & trailers.

Equipment:

Personnel available:

Please provide contact information for the last three landowners or managers you have worked with, and indicate if you are willing to accommodate a visit to prior to beginning operations.

Attach additional sheets if necessary.

Describe your experience specific to farming/grazing/timber operations on National Wildlife Refuges or comparable conservation lands:

List all available equipment in good working condition, for example harvesters, tractors, implements, trucks & trailers. Attach additional sheets if necessary.

Equipment:

Personnel available:

Describe your experience working with non-GMO and non-neonicotinoid treated seeds and limitations on pesticides:

Are you are a certified logger?

Certification:  I hereby certify that I have read and, if selected, agree to the permit conditions listed in the bid package.  The U.S. Fish and Wildlife Service reserves the right to reject any or all bids. I further certify that the information submitted in this bid sheet is complete and accurate to the best of my knowledge and belief.  I understand that any false statement herein may subject me to the criminal penalties of 18 U.S.C. 1001.

Signature: Date: ______________________

NOTICES

All information you provide will be considered in reviewing this application. False, fictitious, or fraudulent statements or representations made in the application may be grounds for revocation of the permit and may be punishable by fine or imprisonment (18 U.S.C. 1001).

Privacy Act Statement

Authority: The information requested is authorized by the National Wildlife Refuge System Administration Act (16 U.S.C. 668dd-ee) and the Refuge Recreation Act (16 U.S.C. 460k-460k-4).

Purpose: To collect the applicant’s information to process permits allowing for commercial activities such as: guiding hunters, anglers or other outdoor users; commercial filming; agriculture; rental of cabins and trapping while on the National Wildlife Refuge System.

Routine Uses: The information will be used by the refuge’s administrative office for processing Commercial Activity Special Use permits. More information about the routine uses maybe found in the Systems of Records Notice, FWS-5 National Wildlife Refuge Special Use Permits.

Disclosure: Providing the information is voluntary. However, submission of information is required to process and approve commercial activity usage on the National Wildlife Refuge System.

Paperwork Reduction Act Statement

We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) to evaluate the qualifications, determine eligibility, and document permit applicants and to respond to requests made under the Freedom of Information Act and the Privacy Act of 1974. The information that you provide is required to obtain or retain a benefit; however, failure to provide all required information is sufficient cause for the U.S. Fish and Wildlife Service to deny a permit. False, fictitious, or fraudulent statements or representations made in the application may be grounds for revocation of the Special Use Permit and may be punishable by fine or imprisonment (18 U.S.C. 1001). According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. OMB has approved this information collection and assigned control number 1018-0102.

Estimated Burden Statement

The public reporting burden for this information collection varies based on the requested specific refuge use. We estimate the relevant public reporting burden for the Commercial Activity Special Use Permit Application form to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Service Information Clearance Officer, U.S. Fish and Wildlife Service, 5275 Leesburg Pike, MS: AMAD-ARM-PPM, Falls Church, VA 22041-3803, or via email to Info_Coll@fws.gov. Please do not send your completed form to this address.

Page 1 of 9